Transcatheter closure of elongated and pulmonary hypertensive patent arterial duct in infants using Amplatzer vascular plug II

Abstract

<jats:title>Abstract</jats:title><jats:sec id="S1047951120000104_as1" sec-type="other"><jats:title>Objective:</jats:title><jats:p>To evaluate the feasibility, efficacy, and safety of Amplatzer vascular plug II in large and elongated ducts in infants.</jats:p></jats:sec><jats:sec id="S1047951120000104_as2" sec-type="other"><jats:title>Introduction:</jats:title><jats:p>Patent arterial duct device closure is technically challenging in infants with large and elongated ducts because Amplatzer duct occluder and Amplatzer duct occluder II have high chances of causing aortic coarctation and left pulmonary artery stenosis, respectively. The Amplatzer vascular plug II being soft with no retention discs on either sides helps in mitigating these problems.</jats:p></jats:sec><jats:sec id="S1047951120000104_as3" sec-type="other"><jats:title>Method:</jats:title><jats:p>This is a prospective, observational study involving infants with clinical, echocardiographic and angiographic evidence of large left to right shunt. All the children underwent duct closure using Amplatzer vascular plug II.</jats:p></jats:sec><jats:sec id="S1047951120000104_as4" sec-type="other"><jats:title>Results:</jats:title><jats:p>Eighteen infants qualified for the study. Mean age and weight were 8.63 ± 3.84 months and 6.3 ± 1.7 kg, respectively. The angiographic mean duct diameter at the pulmonary artery end was 4.66 ± 0.92 mm, and the mean duct length was 9.4 ± 2.48 mm. The size of Amplatzer vascular plug II used varied from 6 mm to 10 mm. Technical success was achieved in 16/18 cases. One patient had device embolisation, and in the other, the device was found to be unstable. The ratio of Amplatzer vascular plug II size to the duct diameter was 1.65 ± 0.27, while the ratio of ductal length to device length was 1.48 ± 0.46 in those with successful outcome.</jats:p></jats:sec><jats:sec id="S1047951120000104_as5" sec-type="other"><jats:title>Conclusions:</jats:title><jats:p>Amplatzer vascular plug II is a safe and effective option in appropriately selected infants with elongated ducts. Diameter and length of Amplatzer vascular plug II vis-a-vis those of the ductus are important determinants of the successful outcome.</jats:p></jats:sec>

Efficacy, Safety and Characteristics of the Amplatzer Vascular Plug II and IV Utilization for Various Percutaneous Occlusions in Children under 10 Years

“…In this multicenter experience, the offlabel utilization of such devices appears effective in children and infants (median age: 1 year). The overall rate of successful AVP implantation (98.5%) constitutes a major indicator of efficacy which compares favourably with previous reports on use of AVPs and other devices formally developed for PDA or vascular occlusions [1][2][4][5][6][7][8][9][10][11][12][13][14]21,[25][26][27][28][29].…”

“…Pertaining to the safety of "off-label" AVP use, we did not experience any major complications using AVP IV, as reported by several authors [1,17,21]. Interestingly, all MAE in our study solely involved PDA closure with AVP II in symptomatic infants ≤5 kg, well identified as being at higher risk during interventional cardiac catheterization [27,30]. On the other hand, this study also brings to light that AVP II remains a suitable alternative for the closure of very large PDAs in symptomatic infants weighing 2 to 6 kg, in whom the deployment of labelled devices might be impossible or at high risk of complications.…”

“…While AVP II allows a fast occlusion, it might currently be under used in children and infants. This might explain the low rate of AVP II implantation in our multicentre study, where it was mainly used for closure of large PDAs [27] and lesions, such as venous ones, that were often too large to fill with AVP IV [12].…”

“…The 6-month occlusion rate is also excellent (98.5%), suggesting adequate mid-term device thrombosis with subsequent endothelialisation. Moreover, to the best of our knowledge, we report the largest patient series in which AVP II and IV are used to occlude several anatomical shunt varieties including large malformations [8,12,14,16,18,21,[25][26][27][28]. In our experience, AVP II and IV offer excellent paediatric "off-label" alternatives for closure of surgical conduits, aorto-pulmonary collaterals, arterio-venous fistulae, acquired veno-venous communications, sequestration closure, and other miscellaneous lesions [5,8,11,12,15,19].…”

“…We report several occlusions of large vessels (median > 5 mm) which is remarkable and rarely reported in infants till now. Off-label use of AVPs with even greater oversizing (150%-160%) could sometimes be indicated in cases of high blood flow (CAF, large arterial collaterals, VSD, large PDAs), severe pulmonary hypertension, surgical conduits, as well as very large, short or even slightly elastic lesions in infants and young children [14,[25][26][27][28]. In our study, the higher number of AVP IV implanted per procedure compared to AVP II reflects the concomitant treatment of several lesions, such as multiple collaterals or multiple feeding vessels.…”